| NPI | 1861515850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 16695) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID 4671481) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2025-11-24 |